Results: Our ED has achieved major improvements in depart mental flow without adding any additional ED or inpatient beds. The mean registration to physician time has decreased from 111 minutes to 78 minutes. The number of patients who left without being seen has decreased from 7.1% to 4.3%. The length of stay (LOS) for discharged patients has decreased from a mean of 3.6 to 2.8 hours, with the largest decrease seen in our patients triaged at levels 4 or 5 using the Canadian Emergency Department Triage and Acuity Scale. We noted an improvement in ED patient satisfaction scores following the implementation of Lean principles

I’m still waiting to get a copy of the whole journal article.

But back to the National Post piece, there’s this quote from an Ontario healthcare leader:

“I believe strongly that we are creating a new norm,” says Tim Burns, who oversees an Ontario government program aiming to apply the Toyota system to 90 of the province’s hospitals by 2011. “There is evidence that it works. It’s a pretty enduring fad.”

Good evidence – yes. “Fad”?? Hmmm…. there are some who are more concerned about the fad-ishness. As Lean gets popular, even trendy, there’s more of a risk that we get more “L.A.M.E.” activity if people have more enthusiasm for Lean than knowledge (or if they don’t have a good mentor or coach).

The article says that “red flags” are going up, among some, about “watered-down” versions of Lean that will not bring lasting change. From the piece:

“A lot of health-care facilities are getting ripped off,” said Tim Hill, a veteran Lean expert based in London, Ont. “There is a lot of hit and miss out there…. You need to instill a problem-solving culture, so you can get to the root cause.”

Hill is right – it’s about more than just tools. Tools and methods mentioned in the piece include value stream mapping, just-in-time, and kaizen (continuous improvement).

So what methods did HDGH use to improve E.D. patient flow?

Staff realized, for instance, that they needed to not only get patients into the department faster, but treat them and discharge them sooner, freeing up beds for other patients. One solution was to put the less-acute patients in a separate stream with their own dedicated staff. That way, the person with a sprained ankle would not be left waiting for hours while his or her nurse concentrated on the patient next door with chest pains.

Porters in the past escorted patients to the X-ray suite, but would only make the trip after collecting several people, bunching up the system. So the hospital painted directional lines on the floors that allowed a constant stream of patients to guide themselves to the imaging room.

This initial success has led to a spread of Lean to other departments, like radiology and pathology.

And it’s not just Windsor:

The Ontario government program has already implemented Toyota Lean at five hospitals in the Waterloo area, bringing about significant — if not dramatic — cuts in wait times and the number of patients leaving before being treated, said Kate Pengelly, ministry lead for the project.

The article highlights some other improvements, but ends with another cautionary note about possible “L.A.M.E.” activity – Lean not properly implemented.

Success with the system, though, is not universal. Prof. Carter acknowledges that Toyota Lean has become a “buzz word” that is not always properly implemented. But at least, he said, the concept has prodded health care to look for waste and inefficiency.

“The word is out there. Lean has lit a fire under people,” said Prof. Carter. “From that perspective, it’s great.

I’ll be in Canada Thursday and Friday, at St. Boniface General Hospital in Winnipeg, another member of our Healthcare Value Leaders Network. They will be hosting a number of us from different Network organizations to learn about some of their Lean improvement efforts.